ABSTRACT Objective: This study investigates the co-prevalence of schizophrenia and incarceration and elucidates a temporal relationship between these conditions, uncovering the interplay between psychiatric morbidity and the social, political, and economic landscape of the U.S. criminal justice system.
Methods: A retrospective analysis utilizing TriNetX (December 2024) queried 60+ U.S. Healthcare Organizations using ICD-10-CM codes to compare the prevalence of schizophrenia in patients with and without electronic health record (EHR) documented incarceration, and conversely, to compare the prevalence of incarceration in patients with and without schizophrenia. Risk of incarceration after schizophrenia diagnosis was compared to risk of incarceration before diagnosis.
Results: Of 80,224 patients with incarceration history, 7.35% had schizophrenia, compared to 0.36% among those without incarceration (RR: 20.3, 95% C.I. 19.8–20.8). Of 423,270 schizophrenics, 1.4% had incarceration history compared to 0.06% amongst non-schizophrenics (RR: 21.6, 95% C.I. 21.0–22.1). Schizophrenia followed incarceration in 1.5% of cases, while incarceration followed schizophrenia in 0.93% (RD: 0.62%, 95% C.I. 0.53–0.71%).
Conclusions: Schizophrenia is overrepresented in incarcerated populations, and incarceration may be a risk factor for schizophrenia presentation. Adopting a medicalized approach to criminal justice may help alleviate the U.S.’s mass incarceration crisis.